Efficacy & Safety of SmofKabiven Emulsion for Infusion vs Hospital Compounded "All in One" for Parenteral Nutrition

Inclusion Criteria: 1. Patient is scheduled to undergo elective gastrointestinal surgery; 2. Female or male patients, age ≥ 18 and ≤ 80 years; 3. Postoperatively, patient is expected to receive 100% of the total daily energy demand via PN for at least 5 consecutive days; 4. Body Mass Index (BMI) ≥ 16 kg/m2 and ≤ 30 kg /m2, and actual body weight ≥ 40 kg; 5. Patient is capable to give Informed Consent, agrees to participate in the study, and signs the Informed Consent Form. Exclusion Criteria: 1. Patient has received PN or parenteral amino acids in the last 10 days before randomization (exception: administration of glucose will be allowed); 2. Known severe liver insufficiency in the medical history, or AST or ALT at least 3.0-times higher than the upper limit of normal range or total bilirubin at least 1.5-times higher than the upper limit of normal range; 3. International Normalised Ratio (INR) at least 1.5 times higher than the upper limit of normal range; 4. Uncontrolled hyperglycaemia defined as fasting blood glucose \> 180 mg/ dl (10 mmol/L); 5. Severe renal impairment defined as serum creatinine value at least 1.5 times higher than the upper limit of normal range; 6. Serious hyperlipidaemia (serum cholesterol and/or triglycerides and/or LDL-C level at least 1.5 times higher than the upper limit of normal range); 7. Known inborn abnormality of amino acid metabolism in the medical history; 8. Known acute pancreatitis in the medical history; 9. Known hypothyroidism or hyperthyroidism in the medical history; 10. Serum level of any of the electrolytes (sodium, potassium, magnesium, total calcium, chloride, phosphate) above the upper limit of the normal range; 11. Known unstable metabolism in the medical history (e.g., metabolic acidosis); 12. Known hypersensitivity to fish, egg, soybean, or peanut protein or to any of the active substances or excipients of the study drugs in the medical history; 13. General contraindications to infusion therapy: acute pulmonary oedema, hyperhydration, and decompensated cardiac insufficiency /congestive heart failure; 14. Unstable haemodynamic conditions (e.g., acute myocardial infarction, stroke, embolism, severe sepsis, shock); 15. Known hemophagocytic syndrome; 16. Patients diagnosed with an infection before the surgery; 17. Drug abuse and/or chronic alcoholism; 18. Psychiatric diseases, epilepsy; 19. Administration of growth hormones within the previous 4 weeks before surgery, or chronic maintenance therapy with systemic glucocorticoids 4 weeks before surgery; 20. Participation in a clinical study with an investigational drug or an investigational medical device within one month prior to start of study or during study; 21. Patient is pregnant or lactating and intends to continue breast-feeding; 22. Development of intraoperative/ postoperative conditions (assessed after surgery and before enrolment of patients): 1. Intra-operative blood loss \> 1000 ml; 2. Development of a condition in which PN is contraindicated; 3. Intra- or postoperative urine output \< 0.5 ml/kg/h; 4. Need for postoperative haemofiltration or dialysis; 5. Contraindication or inability to obtain central venous catheter access; 6. Intra-operative decision on limited treatment, e.g. due to diagnosis of carcinomatosis; 7. Intra-operative severe complications including resuscitation, hemorrhagic and septic shock, acute single and multiple organ dysfunction including pulmonary, hepatic, and renal dysfunction prohibiting early postsurgical extubation, requiring liver-specific treatment and renal replacement therapy.